A new report published by the Guttmacher Institute examines and contributes to the existing evidence on the sexual and reproductive health (SRH) needs of very young adolescents in developing countries. The report includes a new analysis of data on sexual debut, marriage and childbearing before age 15 from national surveys conducted in more than 100 developing countries. Drawing on these data and published literature, the report maps out ways to advance efforts to meet young adolescents’ SRH needs.

Most very young adolescents in developing countries report that they have never had sexual intercourse, though some have begun to engage in other intimate activities, such as kissing, hugging and fondling. Some adolescents in this age-group do have sexual intercourse. In 2016, very young adolescent girls in developing regions had an estimated 777,000 births. While this makes clear that very young adolescents need to be able to access SRH services, including contraception, there is no available evidence on the extent to which such access exists. However, the evidence on the structural, cultural and legal barriers to access faced by older adolescents in developing countries suggests that younger adolescents likely have a very difficult time obtaining SRH care.

“In addition to access to health services, very young adolescents need information about basic sexual and reproductive health issues so they can protect themselves and make informed, healthy decisions,” says Vanessa Woog, a researcher at the Guttmacher Institute and the report’s lead author. “Creating environments in schools and communities that are supportive of young adolescents’ education on sexual and reproductive health topics is critical.”

Primary school may be a particularly valuable setting for providing comprehensive sexuality education (CSE) to very young adolescents: In most developing countries, more than 80% of 10–14-year-olds are in school. Although many developing countries have national policies and curricula in place that support teaching CSE in schools, there is limited evidence on how or whether such curricula are used and what information actually reaches students.

Certain power imbalances and inequitable gender norms put the SRH of very young adolescents at risk. The report found that for many very young adolescents in developing countries, first sexual intercourse happens as a result of coercion or violence instead of choice. In addition, child marriage continues to occur across many cultures and religions worldwide and affects a significant proportion of very young adolescent girls. The United Nations Population Fund estimates that between 2011 and 2020, 50 million girls in developing countries are at risk of being married by age 15.

“Preventing sexual violence is critical to protecting very young adolescents’ sexual and reproductive health and their long-term well-being,” says Anna Kågesten, independent consultant and coauthor of the report. “The prevalence of sexual violence in young adolescents’ lives points to the urgent need to scale up programs that address the root causes of gender-based violence, including those that promote equitable gender norms.”

The researchers urge program planners and policymakers in developing regions to prioritize evidence-based interventions that have been shown to meet the SRH needs of very young adolescents. Suggested areas of focus include increasing the availability of youth-friendly SRH services among adolescents, keeping very young adolescents—particularly girls—in school, implementing national CSE policies and curricula, and addressing the structural and social causes of gender-based violence and child marriage. The authors also highlight the pressing need for more data specifically on 10–14-year-olds’ sexual and reproductive health. More data are also needed on the experiences and needs of young adolescent males, and those of the most vulnerable groups of very young adolescents—to inform programs and policies aiming to effectively meet the SRH needs of every very young adolescent.

This report has been made possible by UK Aid from the UK Government and a grant from The Children’s Investment Fund Foundation. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the UK Government or The Children’s Investment Fund Foundation.